DOCSLIB.ORG

Pseudoangiomatous Stromal Hyperplasia of the Breast Presenting As Gigantomastia: Case Report

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pseudoangiomatous Stromal Hyperplasia of the Breast Presenting As Gigantomastia: Case Report CASE REPORT http://doi.org/10.29289/25945394202020200062 Pseudoangiomatous stromal hyperplasia of the breast presenting as gigantomastia: case report Juliana Pontes Farias1* , Humberto Espínola Guedes Neto1 , Ariano Brilhante Pegado Suassuna1 , Rafael Chaves Claudino de Queiroga1 , Arthur Antonino da Silva Nunes1 , Adriano de Lima Quirino1 , Thaíse Lopes Medeiros1 ABSTRACT Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a benign condition generally seen as an incidental finding of biopsies for other causes. In some rare cases, it can evolve with expressive growth of breast tissue, leading to large breasts. The present study presents a case report of a patient who started with breast hypertrophy during lactation, evolving with gigantomastia, and arrived at the office 3 years after gestation with breasts of 6.2 and 4.3 kg and growth of accessory breast and axillary lymph nodes. The patient was emaciated, with bodily pain and psychological distress. Computed tomography was performed with the finding of diffuse retroglandular nodules and axillary and mediastinal lymph node enlargement, without being able to rule out the lymphoproliferative process. Then, core biopsies were made in several places on the breast whose pathological examination revealed PASH samples. Bilateral mastectomy was performed as a surgical treatment, with resection of the left accessory breast and left axillary lymph node, and breast reconstruction, with placement of silicone prostheses and graft of the areola-papillary complex, together with a plastic surgeon. She evolved in the postoperative period with good healing of the surgical wound, weight gain, necrosis of the areola-papillary complex and with severe psychiatric disorder, which was treated appropriately by psychiatrists, with remission of symptoms. This case report presents a rare evolution of PASH with gigantomastia, bringing intense physical and psychological distress to the patient, whose treatment chosen was total surgical resection of the breast tissue and aesthetic reconstruction. KEYWORDS: breast neoplasms; breast implantation; lactation; mastectomy; pathology. INTRODUCTION CASE REPORT Pseudoangiomatous stromal hyperplasia (PASH) is a rare benign A 27-year-old woman was referred to the outpatient mastology condition of the breasts first described in 19861, most commonly service at the Hospital Universitário Lauro Wanderley (HULW), in found in women in pre- and perimenopause2 with findings on João Pessoa, Brazil, with the complaint of bilateral gigantomas- imaging tests not specific to this condition, requiring a correlation tia accompanied by weight loss. She was seen for the first time with the anatomopathological aspect for diagnostic confirma- in August 2019, reporting breast enlargement that started dur- tion3. PASH can coexist with other breast lesions or even mimic ing pregnancy (three years ago) and worsened during lactation. fibroadenoma and it can progress, in spite of its being a benign After the first consultation, the patient did not attend the disease4. The diagnosis of this condition usually occurs inciden- return visit and only in February 2020 did she return to the clinic tally during investigation with anatomopathological study of for further investigation. The breasts had almost doubled in size other benign or malignant diseases of the breast5. Treatment var- compared to the first consultation, with engorged vessels and ies depending on the presentation. areas with necrosis and suppuration (Figure 1). Diagnostic hypoth- The objective of this study was to report a case with atypical eses were raised for PASH and breast lymphoma, both rare condi- evolution and surgical treatment with bilateral mastectomy and tions. Malignant neoplasm was considered due to rapid growth, immediate reconstruction, since the patient presented a rare and the presence of axillary lymph node enlargement and signifi- diffuse PASH condition beginning in pregnancy with rapid and cant weight loss. Complementary investigation did not include bilateral breast enlargement. mammography due to the patient’s age and, mainly, due to the 1Hospital Universitário João Pessoa, Universidade Federal da Paraíba – João Pessoa (PB), Brazil. *Corresponding author: [email protected] Conflict of interests: nothing to declare. Received on: 10/04/2020. Accepted on: 11/09/2020. Mastology 2020;30:e20200062 1 Farias JP, Guedes Neto HE, Suassuna ABP, Queiroga RCC, Nunes AAS, Quirino AL, Medeiros TL impossibility of performing it in view of the technical limita- tions given the expressive size of the breasts. On the day of the consultation, a computed tomography (CT) scan of the chest was performed, with and without iodinated venous contrast, revealing an important volumetric increase in the breasts due to the multiple confluent nodular formations, predominantly retroglandular, which exhibited slight impregnation by means of contrast, of etiology indeterminate to the method, and it was not possible to discard a lymphoproliferative process. The pres- ence of multiple lymph node enlargement in axillary chains and in the internal chest wall bilaterally also stands out (Figures 2A and 2B). A laboratory screening with general exams and serology was requested to rule out associated conditions and to obtain the necessary exams for surgery. Fragments of the left breast were also collected by means Figure 1. (A) Front view of the breasts; (B) right breast in lateral of a core-biopsy for histopathological analysis. The result was view, with suppurative ulcer; (C) left breast in lateral view and released on February 10th, 2020, revealing breast tissue with accessory breast (photographs taken in February 2020). pseudoangiomatous stromal hyperplasia (morphological aspects Figure 2. (A) Chest computed tomography shows a volumetric increase in the breasts due to multiple confluent nodular formations, predominantly retroglandular; (B) chest computed tomography highlighting the presence of multiple lymph node enlargements in axillary chains and the presence of the accessory breast on the left; (C) surgical parts of the direct and left breast (top to bottom); (D) anatomopathological showing stromal pseudoangiomatous hyperplasia, nodular and diffuse forms; (E) lymph nodes with reactive lymphoid hyperplasia; (F) absence of signs of malignancies. 2 Mastology 2020;30:e20200062 Pseudoangiomatous stromal hyperplasia of the breast presenting as gigantomastia: case report consistent with the diffuse form of PASH) and absence of signs hyperplasia; skin without particularities; absence of signs of malignancy. of malignancy; On March 12th, 2020, the patient underwent bilateral total • Axillary lymph nodes on the left (dimensions = 2.5 × 2 × mastectomy and immediate breast reconstruction by the ser- 0.8 cm): lymph nodes with reactive lymphoid hyperplasia; vices of mastology and plastic surgery, respectively, at HULW. absence of signs of malignancy. Both breasts, the left accessory breast, and the left axillary lymph nodes were resected (Figures 2C and 3A). The areola-papillary In the first postoperative visit, the patient returned without complex was preserved and used as a graft in the reconstruc- complaints. On physical examination, significant edema was tion of the breasts, and silicone prostheses were implanted in a observed in the inframammary folds (Figure 3C). On the sec- submuscular position (Figure 3B). ond return, she presented remission of these findings and com- Surgical specimens were sent for histopathological study at plained of delusions, being referred to the psychiatric service, the Pathological Anatomy Laboratory (Laboratório de Anatomia where drug treatment was started. In the third consultation, Patológica – LAP) of the same hospital (Figures 2D, 2E, and 2F). she showed improvements in psychiatric symptoms and the The results, released on March 26th, 2020, were: removal of the surgical stitches was performed. Partial necrosis • Right breast (weight = 6,255 g; dimensions = 38 × 32 × 10 cm): of the areola-papillary complex grafts and progressive weight pseudoangiomatous stromal hyperplasia, nodular and gain, around 15 kg, were observed in relation to the beginning diffuse forms; skin without particularities; absence of signs of the follow-up (Figure 3D). The possibility of a corrective sur- of malignancy; gical procedure was offered, however, the patient expressed no • Left breast (weight = 4,295 g; dimensions: 29 × 27 × 12 cm): interest in performing a new surgery. pseudoangiomatous stromal hyperplasia, nodular and The study was carried out according to the ethical princi- diffuse; skin without particularities; absence of signs of ples of studies in human beings according to the Declaration of malignancy; Helsinki, with the approval of the Research Ethics Committee • Left accessory breast (dimensions = 11 × 8 × 5 cm): of Hospital Universitário Lauro Wanderley, with CAAE number ectopic breast tissue with pseudoangiomatous stromal 36548520.2.0000.5183. Figure 3. (A) marking and skin flaps after mastectomy; (B) frontal and lateral view of the immediate postoperative period of breast reconstruction after total mastectomy with resection of the left accessory breast; (C) postoperative period of April 2020, showing signs of partial necrosis of the areola-papillary complex grafts; (D) Late postoperative period of September 2020, showing good healing of the surgical wound, in addition to the patient’s weight gain. Mastology 2020;30:e20200062 3 Farias JP, Guedes Neto HE, Suassuna ABP, Queiroga RCC, Nunes AAS, Quirino
Load more

Recommended publications
  • Back Pain: an Assessment in Breast Hypertrophy Patients
    ORIGINAL ARTICLE BACK PAIN: AN ASSESSMENT IN BREAST HYPERTROPHY PATIENTS PAULO MAGALHÃES FERNANDES1, MIGUEL SABINO NETO2, DANIELA FRANCESCATO VEIGA3, LUIS EDUARDODUARDO FELIPE ABLABLA4, CARLOS DELANO ARAÚJO MUNDIM 5, YARAARA JULIANOULIANO6,� LYDIAYDIA MASAKOASAKO FERREIRAERREIRA7 SUMMARY used in order to evaluate the magnitude of back pain and Objective – To evaluate the influence of breast hypertrophy on the limitations arising from these symptoms. Results – The the incidence of back pain and how much they can interfere in mean age of the patients in the study group was 32.2 years patients’ daily activities. Methods – This was a cross-sectional and 32.7 for the control group. The scores in the NRS scale analytic study in patients examined at the Outpatient Ortho- and Roland- Morris Questionnaire were higher in the study pedics and Plastic Surgery Departments at Samuel Libânio group when compared to the control group. Conclusion – The University Hospital in Pouso Alegre, MG. 100 women were results achieved showed that back pain is more severe and examined, 50 presenting breast hypertrophy (study group) determined more extensive limitations in the daily activities and 50 with normal breast size (control group). Breasts were for patients presenting breast hypertrophy. classified according to Sacchini’s criteria. The Numerical Ra- ting Scale (NRS) and the Roland-Morris questionnaire were Keywords: Back pain; Quality of life; Neck pain; Breast. Citation: Fernandes PM, Sabino Neto M, Veiga DF, Abla LEF, Mundim CDA, Juliano Y et al. Back pain: an assessment in breast hypertrophy patients. Acta Ortop Bras. [serial on the Internet]. 2007; 15(4): 227-230. Available from URL: http://www.scielo.br/aob.
    [Show full text]
  • Spectrum of Breast Disorders in a Pediatric Surgery Clinic: Retrospective Study
    Article ID: WMC003775 ISSN 2046-1690 Spectrum of Breast Disorders in A Pediatric Surgery Clinic: Retrospective Study Corresponding Author: Dr. Atilla Senayli, Assistant Prof., Pediatric Surgery, Yildirim Beyazit University - Turkey Submitting Author: Dr. Atilla Senayli, Assistant Prof., Pediatric Surgery, Yildirim Beyazit University - Turkey Article ID: WMC003775 Article Type: Original Articles Submitted on:26-Oct-2012, 05:59:39 AM GMT Published on: 26-Oct-2012, 06:25:34 PM GMT Article URL: http://www.webmedcentral.com/article_view/3775 Subject Categories:PAEDIATRIC SURGERY Keywords:Breast; Disorders; Children How to cite the article:Senayli A, Karaveliolu A , Koseoglu B , Akln M , Ozguner I . Spectrum of Breast Disorders in A Pediatric Surgery Clinic: Retrospective Study . WebmedCentral PAEDIATRIC SURGERY 2012;3(10):WMC003775 Copyright: This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Source(s) of Funding: None Competing Interests: None WebmedCentral > Original Articles Page 1 of 7 WMC003775 Downloaded from http://www.webmedcentral.com on 26-Oct-2012, 06:25:34 PM Spectrum of Breast Disorders in A Pediatric Surgery Clinic: Retrospective Study Author(s): Senayli A, Karaveliolu A , Koseoglu B , Akln M , Ozguner I Abstract Paediatricians must pay attention to breast disorders that may be seen at any paediatric age group. (1). Objective: There are a limited and inadequate data Although most of the diseases are benign as a fact, for breast diseases in children. This may be because the possibility of malignancy can never be ignored of low importance expectations of practitioners' for (1-3).
    [Show full text]
  • Journal of Clinical Review & Case Reports
    ISSN: 2573-9565 Case Report Journal of Clinical Review & Case Reports Pseudo Angiomatous Stromal Hyperplasia of the Breast: A Case of A 19-Year-Old Asian Girl Yuzhu Zhang1, Weihong Zhang2# , Yijia Bao1, Yongxi Yuan1,3* 1Department of Mammary gland, Longhua Hospital Affiliated to Shanghai University of TCM, Shanghai, China *Corresponding author 2Department of Mammary gland, Baoshan branch of Shuguang Yongxi Yuan, Department of Mammary gland, Longhua Hospital Hospital Affiliated to Shanghai University of TCM, Shanghai,201900, Affiliated to Shanghai University of TCM & Huashan Hospital, China. Shanghai Medical College, Fudan University, Shanghai, China. Tel: +8602164383725; Email: [email protected] 3Department of Mammary gland, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China Submitted: 11 Oct 2017; Accepted: 20 Oct 2017; Published: 04 Nov 2017 #co-first author Abstract Pseudoangiomatous stromal hyperplasia (PASH), a benign disease with extremely low incidence, is manifested as giant breasts, frequent relapse after surgery, or endocrine disorder. Cases with unilateral breast and undetailed endocrine condition have been reported in African and American. In this case, a 19-year-old Asian girl suffered from bilateral breast PASH after the human placenta and progesterone treatment for 3-month delayed menstruation. Her breasts enlarged remarkably 1 month after the treatment, with extensive inflammatory swell in bilateral mammary glands and subcutaneous edema in retromammary space. The patient received the bilateral quadrantectomy plus breast reduction and suspension surgery to terminate the progressive hyperplasia of breast. During the whole treatment period, the patient was given tamoxifen treatment for 4 months, and endocrine levels were intensively recorded. The follow-up after 4 months showed recovered breast with normal shape and size, and there was no distending pain, a tendency toward breast hyperplasia, or menstrual disorder.
    [Show full text]
  • Juvenile Breast Hypertrophy
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Via Medica Journals ONLINE FIRST This is a provisional PDF only. Copyedited and fully formatted version will be made available soon. ISSN: 0423-104X e-ISSN: 2299-8306 Juvenile breast hypertrophy Authors: Benedita Bianchi de Aguiar, Rita Santos Silva, Carla Costa, Cintia Castro-Correia, Manuel Fontoura DOI: 10.5603/EP.a2019.0063 Article type: Clinical Vignette Submitted: 2019-12-07 Accepted: 2019-12-16 Published online: 2020-01-07 This article has been peer reviewed and published immediately upon acceptance. It is an open access article, which means that it can be downloaded, printed, and distributed freely, provided the work is properly cited. Articles in "Endokrynologia Polska" are listed in PubMed. The final version may contain major or minor changes. Powered by TCPDF (www.tcpdf.org) Juvenile breast hypertrophy Benedita Bianchi de Aguiar1, Rita Santos Silva2, Carla Costa2, Cintia Castro-Correia2, Manuel Fontoura2 1Paediatrics Department, Centro Hospital Entre Douro e Vouga, Portugal 2Paediatrics Endocrinology, Centro Hospitalar Universitário de São João, Portugal Correspondence to: Benedita Sousa Amaral Bianchi de Aguiar, Rua Marta Mesquita da Câmara 175 Apt 62 4150-485 Porto, Portugal, tel: (+351) 913 166 913; e-mail: [email protected] Case description Juvenile breast hypertrophy (JBH), also called virginal hypertrophy or macromastia, is a rare benign condition, in which one or both breasts undergo a massive increase in size duringin puberty, usually around menarche. We present a clinical case of JBH and discuss the available therapeutic options. An 11-year- old female patient was referred to our paediatric endocrinologist consultant due to breast hypertrophy.
    [Show full text]
  • W O 2019/232146 Al 05 December 2019 (05.12.2019) W IPO I PCT
    (12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property (1) Organization11111111111111111111111I1111111111111i1111liiiii International Bureau (10) International Publication Number (43) International Publication Date W O 2019/232146 Al 05 December 2019 (05.12.2019) W IPO I PCT (51) International Patent Classification: JIANG, Zaoli; 20 Cedar Rock Road, Woodbridge, Con A61K31/19(2006.01) A61K45/00(2006.01) necticut06525(US). A61K38/12 (2006.01) A61K 45/08 (2006.01) (74) Agent: DOYLE, Kathryn et al.; Saul Ewing Arnstein & (21) International Application Number: Lehr LLP, 1500 Market Street, 38th Floor, Philadelphia, PCT/US2019/034548 Pennsylvania 19102 (US). (22) International Filing Date: (81) Designated States (unless otherwise indicated, for every 30 May 2019 (30.05.2019) kind ofnational protection available): AE, AG, AL, AM, AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, BZ, (25)FilingLanguage: English CA, CH, CL, CN, CO, CR, CU, CZ, DE, DJ, DK, DM, DO, (26) Publication Language: English DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, HN, (30)PriorityData: HR, HU, ID, IL, IN, IR, IS, JO, JP, KE, KG, KH, KN, KP, (30)/Priority : 01 June 2018 (01.06.2018) us KR, KW, KZ, LA, LC, LK, LR, LS, LU, LY, MA, MD, ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, (71) Applicant: YALE UNIVERSITY [US/US]; Two Whitney OM, PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, Avenue, New Haven, Connecticut 06510 (US). SC, SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, ZA, ZM, ZW.
    [Show full text]
  • Chronic Cystic Mastitis with Special Relation to Carcinoma
    University of Nebraska Medical Center DigitalCommons@UNMC MD Theses Special Collections 5-1-1937 Chronic cystic mastitis with special relation to carcinoma John D. Hamer University of Nebraska Medical Center This manuscript is historical in nature and may not reflect current medical research and practice. Search PubMed for current research. Follow this and additional works at: https://digitalcommons.unmc.edu/mdtheses Part of the Medical Education Commons Recommended Citation Hamer, John D., "Chronic cystic mastitis with special relation to carcinoma" (1937). MD Theses. 512. https://digitalcommons.unmc.edu/mdtheses/512 This Thesis is brought to you for free and open access by the Special Collections at DigitalCommons@UNMC. It has been accepted for inclusion in MD Theses by an authorized administrator of DigitalCommons@UNMC. For more information, please contact [email protected]. CHRONIC CYSTIC IvIASTITIS va th Special Relation to Carcinoma Senior Tbesis Presented to the University of Nebraska College of Medicine by .John D. Hamer INTRODUCTION The purpose of this paper is to better acquaint the student wi th the ever changing views of investigators regarding the relationship of Chronic cystic mastitis to carcinoma of the breast. The Buthor has borne in mind that until recent years very little work of an experimental nature has been done in this field. Consequently the material from which this paper is made up has been ex­ tracted from current articles upon this subject. He has set down clinical find­ ings, experimental results, and theories of the different workers with an open mind. He has tried not to form an opin­ ion but would rather let the reader form come to his own conclusions, 480871 CHRONIC CYSTIC 1MSTITIS Definition - Chronic Cystic Mastitis is a misnomer.
    [Show full text]
  • Pediatric and Adolescent Breast Masses
    Pediatric Imaging • Review Kaneda et al. Pediatric and Adolescent Breast Masses Pediatric Imaging Review Pediatric and Adolescent Breast Masses: A Review of Pathophysiology, Imaging, Diagnosis, and Treatment Heather J. Kaneda1 OBJECTIVE. Pediatric breast masses are relatively rare and most are benign. Most are Julie Mack either secondary to normal developmental changes or neoplastic processes with a relatively Claudia J. Kasales benign behavior. To fully understand pediatric breast disease, it is important to have a firm Susann Schetter comprehension of normal development and of the various tumors that can arise. Physical ex- amination and targeted history (including family history) are key to appropriate patient man- Kaneda HJ, Mack J, Kasales CJ, Schetter S agement. When indicated, ultrasound is the imaging modality of choice. The purpose of this article is to review the benign breast conditions that arise as part of the spectrum of normal breast development, as well as the usually benign but neoplastic process that may develop within an otherwise normal breast. Rare primary carcinomas and metastatic lesions to the pediatric breast will also be addressed. The associated imaging findings will be reviewed, as well as treatment strategies for clinical management of the pediatric patient with signs or symptoms of breast disease. CONCLUSION. The majority of breast abnormalities in the pediatric patient are be- nign, but malignancies do occur. Careful attention to patient presentation, history, and clini- cal findings will help guide appropriate imaging and therapeutic decisions. hough breast masses are uncom- mary breast cancer is extremely low in the pe- mon in the pediatric population, diatric population, reducing the utility of mam- the detection of an abnormality is mography as a diagnostic problem-solving tool T often alarming to caregivers and [1].
    [Show full text]
  • Laktation & Stillen
    LactationLaktation & Breastfeeding & Stillen ZeitschriftMagazine der of theEuropäischen European LactationLaktationsberaterinnen Consultants Alliance Allianz • www.elacta.eu • ISSNISSN 1614-807x1614-807x COVER STORY PRACTICAL KNOW HOW PRACTICAL KNOW HOW Breastfeeding After Cosmetic Infant Hand Movements During Do Mothers Really Have The Choice th Breast Surgery – page 15 Breast Seeking – page 6 To Breastfeed? – page 10 3 • 2017 30 Volume Foto: Field exchange 48 2 EDITORIAL EDITORIAL Dear members, dear colleagues, dear readers, IMPRINT summer has gone, it has started raining, the wind is blow- Company Information: ELACTA European Lactation ing and leaves are falling from trees. In this ELACTA mag- Consultants Alliance azine you will find some nice issues to read about, even by www.elacta.eu authors from overseas. About situations that will come up Email: [email protected] ZVR-Nr.: 708420941 unexpectedly and are sometimes unwanted. Our profession is really important, also after hospitalization. Convince your ELACTA president: Karin Tiktak, IBCLC colleagues and other health care providers about the impor- [email protected] tant role you play as an IBCLC. Editorial and project Actually the ELACTA board is writing this editorial from coordination: Opatija in Croatia. It is a beautiful place where one of our Eva Bogensperger-Hezel, IBCLC board members lives and does her job as an IBCLC in her pri- Email: [email protected] vate practice. We have board meetings on Friday and Saturday Team: from 9 am to 5 pm. During this enjoyable time together, we Andrea Hemmelmayr, IBCLC Elke Cramer, Ärztin, IBCLC bridge the differences we experience in lactational care. Be- Kathrin Meier, IBCLC ing the president of this important association makes me feel Bärbel Waldura, IBCLC grateful and responible.
    [Show full text]
  • Gynecomastia Info
    Page 1 of 4 GYNECOMASTIA TYPES AND TREATMENTS by JAMES ROMANO, MD Gynecomastia is usually strictly defined as the visible or palpable development of breast tissue in men. The term comes from the Greek words gyne meaning "woman" and mastos meaning "breast." In practical terms, this means abnormally large breasts on men. This is often related to the occurrence of excess fat or, less frequently, overdeveloped muscles. The condition is relatively common in adolescent boys, and 90% of the time symptoms disappear in a matter of months, or, as adolescence wanes, a few years later. But the remaining 10% are burdened with a social handicap that causes a deep and complex shame, and often puts a man’s relationship with his body into an altered state. Drugs, medications, hormonal imbalance, genetic conditions, and exogenous hormones can all cause gynecomastia. During puberty it is normal for most boys to develop some proliferation of breast tissue. This is often make known by the onset of pain in the nipples or sub-areolar region. Ordinarily this condition is self-limited and subsides within 6 to 18 months. When this gynecomastia persists, it is often embarrassing and psychologically debilitating. Removal of the excess breast parenchyma is the only effective treatment. This condition can be accentuated if the patient is overweight. Marijuana usage is commonly linked to gynecomastia. Men who are taking estrogens or testosterone inhibitors because of prostate cancer or patients with liver disease who have a hormonal imbalance are also susceptible to this condition. Gynecomastia can develop as a result of taking anabolic steroids to enhance athletic performance or bodybuilding.
    [Show full text]
  • Neonatal Breast Hypertrophy
    & The ics ra tr pe a u i t i d c e s P Pediatrics & Therapeutics Donaire et al., Pediatr Ther 2016, 6:3 ISSN: 2161-0665 DOI: 10.4172/2161-0665.1000297 Case Report Open Access Neonatal Breast Hypertrophy: Revisited Alvaro Donaire, Juan Guillen and Benamanahalli Rajegowda* Department of Pediatrics, Lincoln Medical and Mental Health Center, USA *Corresponding author: Benamanahalli Rajegowda, Department of Pediatrics, Division of Neonatology, Lincoln Medical and Mental Health Center, 234 East 149th Street, Bronx, New York, 10451, USA, Tel: 718-579-5360; Fax: 718-579-4958; E-mail: [email protected] Received date: Jun 28, 2016, Accepted date: Jul 14, 2016, Published date: Jul 18, 2016 Copyright: © 2016 Donaire A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited. Introduction Neonatal breast enlargement is a benign condition that may be seen during the first days of life in the neonatal period and it has been reported to occur in 65-90% of infants. Within few months after birth it usually involutes, and later regrows during puberty due to hormonal stimulation. Breast enlargement is uncommon, when it occurs is a benign physical finding [1]. Neonatal galactorrhea, commonly referred to as witch’s milk, is a cloudy discharge from the breasts that occurs when estrogen and progesterone levels decrease after delivery, enabling the secretion of prolactin and oxytocin from the neonate’s pituitary [2]. The “witch’s milk” resembles the maternal milk composition, the milk comes only when the breast are expressed.
    [Show full text]
  • Macromastia - Reduction Mammoplasty
    Macromastia - Reduction Mammoplasty Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the breasts by removing excess fat, glandular tissue and skin. The procedure is performed in ​ order to alleviate or correct medical problems caused by excessive breast tissue. Women ​ presenting with various forms of breast hypertrophy accompanied by persistent clinical signs and symptoms that adversely affect health are the principal candidates for breast reduction surgery. Note: Reduction mammoplasty performed as part of gender affirming surgeries are NOT ​ covered under this clinical criteria. Reduction mammoplasty will be considered for coverage when ALL of the criteria below are ​ met, confirmed with supporting medical documentation. I. Criteria for Initial Approval ● Documentation of a functional impairment (defined as adverse effect on activities of daily living) related to at least two of the following: ​ ​ ○ Chronic pain ■ Chronic headaches. ■ Chronic upper back, neck, breast or shoulder pain. ○ Skin changes ■ Signs and symptoms of intertriginous maceration and/or infection of the inframammary skin (e.g., hyperpigmentation, bleeding, chronic moisture, and evidence of skin breakdown refractory to dermatologic measures). ■ Shoulder grooving from bra straps. ○ Arthritic changes ■ Signs and symptoms of nerve compression that are unresponsive to medical management (e.g., ulnar paresthesias) and evidenced ​ by nerve conduction studies. ■ History of significant arthritic changes in the cervical or upper thoracic spine. ■ Thoracic outlet syndrome. ■ Acquired kyphosis that is attributed to macromastia. ○ Dysmorphic Syndrome ■ Depression/significant anxiety related to macromastia. 1 ● Medical opinion that these functional impairments are attributable to macromastia. ○ Documented exclusion of alternative etiologies (e.g., such as arthritis, multiple sclerosis, cervical spine disease, etc.) have been adequately ruled-out by means of diagnostics, as applicable.
    [Show full text]
  • Breast Diseases in Children: the Spectrum of Radiologic Findings in a Cohort Study
    Diagn Interv Radiol 2017; 23:407–413 BREAST IMAGING © Turkish Society of Radiology 2017 ORIGINAL ARTICLE Breast diseases in children: the spectrum of radiologic findings in a cohort study Emel Durmaz PURPOSE Murat Alp Öztek We aimed to investigate the spectrum of radiologic findings and referral reasons for breast dis- Hatice Arıöz Habibi eases in children considering age-appropriate presentation. Uğur Kesimal METHODS Hakkı Timur Sindel Our retrospective cohort study included 348 consecutive pediatric patients aged <19 years (me- dian, 13 years) referred to radiology with a clinical presentation between 2005 and 2016. Radio- logic findings were reviewed in four age ranges (0–2 years, 2–8 years, 8–15 years, >15 years). RESULTS Of 348 patients, 257 had a referral reason. The most frequent referral reason was a palpable mass (35%). Developmental abnormalities accounted for 48% of all radiologic findings in 348 patients. We did not detect any breast malignancy. According to age groups, the most common radiologic findings were neonatal hypertrophy (0–2 years), early breast development (2–8 years), develop- mental abnormalities by a majority of gynecomastia (8–15 years), and normal findings or devel- opmental abnormalities (>15 years). Interestingly, the frequency of gynecomastia was only 4% in neonatal period or early childhood. Fibroadenomas and fibroadenoma-like solid masses were seen after 8 years and constituted the majority of solid masses (65%). Cysts were seen at a rate of 7% and majority of them were of simple type, which tends to resolve in time. CONCLUSION In our study, the most common referral reason to radiology was a palpable breast mass.
    [Show full text]